SOS Errors: Don’t Let Your First Find Be Your Final Answer

How the Satisfaction of Search (SOS) cognitive bias impacts diagnostic accuracy

It’s a busy night in January for the radiology registrar. The CT scanner in A&E is running so non-stop that it might as well come with a "Do Not Disturb" sign. The phone keeps ringing with the surgeons eagerly checking if their latest CT abdomen pelvis has been vetted (spoiler: it’s never soon enough).

Our weary registrar finally pulls up the first scan. The history: generalised lower abdominal pain, negative pregnancy test, raised inflammatory markers. “Not too bad,” he thinks. Within seconds, he spots an inflamed appendix with fat stranding. Bingo. Acute appendicitis. “Done!” he declares, happily slapping the report together, ready to move on to the next report and bask in the consultant addendum's inevitable praise tomorrow morning.

But wait—the story doesn’t end there. What the registrar missed in his haste was an incidental adrenal mass on the opposite side. Not just any mass, mind you, but a malignant adrenocortical carcinoma, which could have been caught with a bit more attention.

This, my friends, is Satisfaction of Search (SOS) error. It happens when we get so excited about solving the first puzzle that we skip over the rest of the picture. Our initial “aha!” moment makes us prematurely end the search. And it’s not just limited to radiology—every speciality is prone to it.

On the flip side, if we don’t find anything at first glance, we often get “search-happy,” scanning through images like a detective with an overactive imagination, misidentifying random artefacts as pathology. It’s a delicate balance—one that reminds us to always keep searching, even after finding something that looks like it could be the culprit.

So, the next time you spot an abnormality, maybe it warrants a pause before you move on. Maybe there's another sneaky pathology lurking in the shadows, waiting for you to spot it. Fight the bias, and make sure the only thing you’re “satisfied” with is your thoroughness.

The Curious Case of Doctors and Their Low Sick Rates

In August 2024, the NHS’ sickness rate hit 4.8%, but hospital doctors? Just 1.7%. Odd, isn’t it? The frontline staff exposed to sneezes, coughs, and assorted bodily fluids are off sick less than other clinical staff along with office-based managers crunching spreadsheets.

What’s going on here? Maybe a case of bulletproof immunity (despite the weak evidence to suggest so), but perhaps more about a cultural epidemic. Doctors drag themselves in because calling in sick feels unthinkable when patients and colleagues are counting on them. Meanwhile, managers—blissfully far from germs—somehow clock higher absence rates.

The irony? Doctors who battle viruses head-on are less likely to call in sick than those safely ensconced in meeting rooms.

​​Corridor Care: A Compromise Too Far?

Can we really accept this as the new normal?

The NHS’s Principles for Providing Safe and Quality Care in Temporary Escalation Spaces, published in 2024, makes a clear assertion: no patient ill enough to be in hospital can be adequately cared for in a corridor, a car park, or a waiting area. It’s a compelling statement, but is it grounded in the reality faced by an overstretched NHS? The sight of patients parked in corridors doesn’t just jar with the image of a G7 nation and one of the richest countries in the world—it also raises pressing moral and practical dilemmas.

Many patients in the UK receive care in settings that are far from appropriate. A recent survey by the Royal College of Nursing found that 67% of nursing staff deliver care daily in spaces like corridors and even converted cupboards. In response, some hospitals have created roles such as ‘patient support workers,’ tasked with patrolling these improvised spaces to monitor patients and alert clinicians if someone’s condition deteriorates.

For patients, being cared for in a corridor offers little dignity or comfort. Harsh lighting, constant noise, and a lack of privacy compound the stress of being unwell. While one might argue that corridor care is better than no care at all, this bare minimum approach comes at a cost. Patients in these conditions are often out of sight of clinical staff, which can delay intervention during critical moments.

For healthcare professionals, the implications are equally troubling. Moral injury—a sustained disconnection between personal and professional expectations and a reality that prevents their fulfilment—is an inevitable consequence of caring in these conditions. For doctors and nurses, being unable to provide the level of care they were trained for not only affects morale but also their mental health.

The problem isn’t simply about a lack of hospital beds. It’s about the entire flow of the healthcare system. A&E departments become makeshift holding areas because patients can’t be admitted to wards with no free beds. Wards, in turn, are filled with patients who are medically fit for discharge but unable to leave due to inadequate social care provision in the community. The result is a system that clogs at every level, with no pressure valve to release the strain.

If this sounds like a scenario from a dystopian drama, consider this: when train stations breach their capacity, emergency protocols are enacted, stations close, and trains are halted. But hospitals, no matter how overcrowded, have no such option. There’s no way to stop the influx of patients because they can’t simply “come back later.” The result is a relentless stretch of resources that puts everyone—patients and staff alike—at risk.

As these debates continue, one thing is certain: accepting corridor care as a new normal is neither sustainable nor ethical. It’s a compromise too far, one that ultimately harms everyone involved.

“Wild Night shift request of the week - ‘We need a DRE to check on a patient, it seems he is no longer breathing”

“IMT Application season - back in 2016 core medical training interviews I was told I had a job as long as I had a stethoscope and a pulse. Today you need a neurosurgery portfolio”

“Radiology 2025 portfolio no longer contains distinction in medical school. Being good at medical school does not deserve any further merit. Next year you might not even need a medical degree.”

“A word to the commenter above - we know that prizes, awards, and audits are susceptible to so-called ‘fake evidence’ where consultants can easily sign off false letters. You may sigh, but forging evidence does happen, more prevalently from graduates coming from abroad.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

Are doctors exhausted by our patients, or by the poorly managed systems in which we work? (The Guardian)

Our ICU colleagues swear by Deranged Physiology - useful for anyone wanting to understand complex physiology through bitesize reading.

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Data-Driven Workforce Insights From The GMC

Buckle in for some concrete stats from the GMC. We hear talk of doctors moving on from the NHS daily but in 2022, 3.8% of our doctor workforce left the NHS, dropping to 3.6% in 2023. The IMG PLAB exam has become the largest single route to UK doctor registration (overtaking UK medical school supply). 52% of non-UK graduates joining in 2023 came from just five countries: India, Pakistan, Nigeria, Egypt, and Bangladesh. The licensed doctor population is now almost evenly split: 49% female and 51% male.

The proportion of F2 doctors opting not to even apply for core or speciality training in the same year they completed F2 increased from 44% in 2017 to 56% in 2021. Of the 2022 F2 cohort, only 25% entered core or speciality training within a year of finishing F2.

For those who did apply in the same year as finishing foundation training, just 8% received no offers—meaning 92% secured an opportunity of some kind.